AB1273 RARE INFECTION RELATED ARTHROPATHIES IN RHEUMATOLOGY: A MULTI-CENTRIC STUDY
Authors: A. Pandey, A. Dua, S. Jain, B. D. Pandey
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Various infections can mimick inflammatory arthropathies and misdiagnosed as rheumatoid arthritis, Spondyloarthritis or lupus. Occasionally, rare infections prevalent in a specific geographical region may present with arthritis as their first and only symptom which may confuse the clinician leading to incorrect diagnosis and management. Many a times, such patients land up in a rheumatology clinic prior to the diagnosis. Hence, Rheumatologists practicing worldwide should be aware of such manifestations of infectious diseases. <h3>Objectives</h3> Main objective of this multi-centric study was to appraise the clinical features and demographics of various rare infectious diseases (newly or previously diagnosed) that presented with arthritis. <h3>Methods</h3> This retrospective study (January 2022- December 2022) was carried out at 3 tertiary care centres, two in central India (city Indore and Bilaspur) and 1 in northern India (city Saharangpur). Patients who were previously diagnosed with an infectious disease and presented with arthritis were included. Patients with arthritis who were diagnosed as infectious disease were also included. Their details regarding demographics and clinical presentations were collected. Pearson chi-square test was applied and cases were studied according to their Age, Sex, distribution of joints, rheumatoid arthritis (RA) factor and anti cyclic citrullinated peptide (anti-ccp) antibodies positivity,presence of myalgias, rashes, extra-articular manifestations and cutaneous manifestations. <h3>Results</h3> Seventy- nine patients (39 male) were identified. Out of these,34 (43%) patients had chikungunya arthritis, 12 (15.2%) leprosy, 11 (13.9%) Covid-19, 10 (12.9%) Dengue, 4 (5.1%),Hepatitis C, 4 (5.1%) HIV, 3 (3.8%) HCV and 1 (1.3%) Poncet's disease. No significant association was seen among rheumatoid factor (p=0.494) or anti-ccp antibodies positivity (p=0.987) with these diseases. Patients with chikungunya had oligoarthritis (14.7%) or polyarthritis (85.3%). Patients with Covid-19 had oligoarthritis (18.2%), polyarthralgia (27.3%) and polyarthritis (54.5%). Patients with dengue, HCV and Poncet's disease had only polyarthritis. Majority of the patients with hepatitis C and leprosy had polyarthritis. Patients with HIV showed enthesitis (25%), oligoarthritis (25%) and polyarthritis (50%). There was a statistically significant association between presence/ absence of myalgia and infectious diseases (P=0.001). It was absent in patients with hepatitis C. Only about one-third of the patients with leprosy had myalgia; while most of the patients with other infectious diseases had myalgia. 20% of the dengue patients and 41.7% of the leprosy patients had rashes, while rashes were absent in patients with other infectious diseases. Erythema nodosum was seen in only 25% patients with leprosy; while it was absent in the patients with other infectious diseases. Extra-articular manifestations were seen in 35.3% patients with chikungunya, 9.1% with Covid-19, 20% with dengue, 25% with hepatitis C, 33.3% with leprosy and 100% patients with Poncet's disease; while extra-articular manifestations were not seen in patients with HCV and HIV infection. 9.1% patients with Covid-19, 25% with hepatitis C, 25% with HIV, 83.3% with leprosy had cutaneous manifestations, while cutaneous manifestations were not seen in patients with chikungunya arthritis, dengue, HCV and Poncet's disease. <h3>Conclusion</h3> Rheumatological manifestations of various infections can mimic various inflammatory arthritis and can be a diagnostic challenge. Apart from the joint involvement, these infections can also have various extraarticular manifestations as well. One should be aware of such manifestations as increased awareness can prevent diagnostic delay and complications. <h3>Reference</h3> [1]Sharma V, Sharma A. Infectious mimics of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2022 Mar;36(1):101736. doi: 10.1016/j.berh.2021.101736. Epub 2021 Dec 31. PMID: 34974970. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.